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Salter-Harris fractures

Salter-Harris fractures are epiphyseal plate fractures and are common and important as they can result in premature closure and therefore limb shortening and abnormal growth.

Epidemiology

They represent ~ 35% of all skeletal injuries in children.

Clinical presentation

They typically occur in the 10-15 year old child.

Pathology

The growth plate has five distinctive zones. Fractures tend to propagate along the weakest zone, which is the spongiosum. Fortunately this is not a region of active growth, and therefore fractures through this area have a good prognosis. When the fracture passes towards the epiphysis, it passes through the zones of proliferation and reserve which result in possible premature closure of the growth plate at the fracture site.

Classification

Conveniently the Salter-Harris types can be remembered by the mnemonic SALTR.

type I

slipped

5-7%

fracture plane passes all the way through the growth plate, not involving bone